What has your training at the Wills Eye Institute and your membership in the Spaeth Fellows Society meant to you professionally and personally?
Wills Eye is such a special place for training. While there, I trained under George Spaeth, MD; Richard Wilson, MD; Jay Katz, MD; and Marlene Moster, MD. They are just a few of the great glaucoma specialists at that facility. Most of the Spaeth fellows seem to be productive. Somehow, Dr. Spaeth and the other glaucoma faculty can pick people who are driven. That is not by accident. Dr. Spaeth is extremely perceptive and motivated to do the best for his patients. That is why he wanted to develop a legacy of glaucoma specialists who care for the patient.
What are the top lessons you drew from your years chairing OMIC's Risk Management Committee?
We really did not know much about ophthalmology- specific lawsuits until OMIC. During the 1980s, we were forced to start our own ophthalmology-specific malpractice insurance company; we developed programs to help keep us out of trouble and enhance communication with patients. These efforts have positively affected the oph- thalmologist by lowering the cost of medical malpractice insurance. A key lesson I learned is that a board's conservative approach usually has a purpose. For example, it helped avoid the huge losses that other companies sustained with LASIK. There were surprisingly few glaucoma claims during the years I was on the OMIC board, where- as some of the most expensive involved a missed brain tumor.
How has the introduction of automated visual field examinations affected patients' care?
Patients and practitioners have a love-hate relationship with visual fields. We clinicians need to measure how much the disease is changing, and all of us want an objective test. The reality, however, is that vision is functional and subjective. There will probably continue to be some sort of functional test to validate any structural test we use. Even if we could count the actual number of ganglion cells lost, the real problem is that patients only care about vision loss. We know that, if visual field damage is en- croaching on fixation or is progressing rapidly, the patient requires more attention to control his or her disease. Some of the different tests that attempt to isolate the different functions of the ganglion cells, such as frequency doubling or short-wavelength perimetry, may help in correlating early structural change with supportive functional loss that is not seen on standard perimetry. I do believe, therefore, that automation has improved our care of patients.
Do financial disclosures mean anything, or should they be abandoned?
Financial disclosures have some meaning to the audience. If the speaker has no financial interests, the presentation may be balanced. On the other hand, if the speaker has a significant number of disclosures, perhaps he or she will deliver an even more balanced presentation because of his or her knowledge. As a horse is led to water, it may not drink but is shown the way; if an audience is led to a conclusion, I give them credit for being smart enough to know whether or not they buy it. In the long run, I am not sure that nonindustry talks will be good for us. We will lose the ability to chat about patients and practices. There has been a big push to have continuing medical education (CME) events approved by academic review. This effort is leading to much more structured events. I understand and support review pro- cesses, but perhaps this change is itself leading to a conflict of interest. After all, the academic “industry” is not disclosing how much it receives to run a CME event. If it is paid large sums of money to approve a CME event, isn't that a bias of sorts? More- over, this group controls the content of the presentations at times, and it may choose the content that benefits the institution it represents, such as promotion of the faculty.
How do you balance your personal and professional responsibilities?
There is a big swing back and forth in the amount of time I devote to my professional and personal responsi- bilities. A few years ago, I was working out and training for an Ironman triathlon. (I never did complete that project.) I said no to everything out- side of that effort. It is tough to have all the time I need for everything— especially when more comes my way.
Years ago, I went through the 7 Habits course. Recently, I attended the Ritz Carlton Leadership Conference. What is clear to me is that, if you do what you love with excellence and passion, you will be more successful. On most days, I still love glaucoma and ophthalmology, despite all the stresses of decreasing revenue and longer hours.
The reality is that most of my activities are a mix of personal and professional. For instance, I will take a short trip for fun after a meeting. Going back and forth between unbalanced personal and professional demands has not been a bad way to live. I find that I am not unhappy one way or the other if the demands take me in a certain direction, but I do try to reserve time for my friends and family.
